Combined Low-Dose Isotretinoin and Sequential Multimodal Laser Therapy for Active Acne and Erythematous Atrophic Scars: A Five-Patient Case Series.

The simultaneous presence of active inflammatory acne and atrophic acne scarring represents a challenging clinical scenario. Although isotretinoin remains the gold standard for severe acne, its combined use with laser procedures has historically been restricted due to safety concerns regarding wound healing. This study aimed to evaluate the safety and clinical efficacy of low‑dose systemic isotretinoin combined with sequential multimodal laser therapy for the concurrent treatment of active acne and atrophic acne scars. This retrospective case series included five patients with severe inflammatory acne and atrophic scarring treated with fixed low‑dose isotretinoin (20 mg/day) alongside a sequential multimodal laser protocol, based on non‑ablative fractional 1,540 nm laser, with fractional CO₂ and 1,064 nm Nd:YAG lasers introduced selectively and sequentially according to clinical criteria. Acne severity was assessed using the Investigator's Global Assessment (IGA), while scar severity was evaluated using the Echelle D'Evaluation Clinique des Cicatrices D'Acne (ECCA) score and the Goodman & Baron quantitative scale. Outcomes and adverse events were recorded over a three‑month follow‑up. All patients achieved near‑complete or complete acne clearance (IGA 0-1) within one month of treatment initiation, with results maintained at the three‑month follow‑up. Clinically meaningful improvements in scar severity were observed, with mean reductions of 87.9% in ECCA scores and 84.4% in Goodman & Baron scores. No serious adverse events or impaired wound healing were reported. This case series suggests that low‑dose isotretinoin can be safely combined with sequential multimodal laser therapy to simultaneously address active inflammatory acne and severe atrophic scarring. Larger prospective studies are warranted to confirm these findings and optimize treatment protocols.